Optimize Quality of Care Revenue (STARS and HEDIS)

Optimize Quality of Care Revenue (STARS and HEDIS)

Optimize Revenue, Optimize Quality of Care

To measure is to know. For health plans managing complex populations that may include government beneficiaries, measuring and reporting is the path to optimizing quality scores and financial incentives.

Simply put, health plans need aggregated, usable data to prove the value of their programs and interventions and earn revenue tied to them. Qualifying for federal quality incentives means surpassing other health plans on rating systems such as NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) measures or CMS’ Star Ratings. But that’s not always easy when caring for members with high rates of chronic conditions, cognitive impairments and functional limitations.

Plans must prove they can effectively manage both clinical and financial risk.

Maximize reimbursements under value-based programs like HEDIS and Star Ratings

To do this, health plans need ways to track, analyze and manage provider and member performance. They need a care management program to more accurately manage member outcomes, reduce cost of care and enable complex care management. Medecision puts care management strategies to work by delivering the power to:

Identify and integrate multiple sources of data to directly align with Medicare, Medicaid and other government-specific reports and requirements—including HEDIS and Star Ratings

Identify at-risk and rising-risk members sooner to drive more effective interventions